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Waste Tire •vey & Inspection Re `"t SURVEY REQUIRE <br /> s _ State California <br /> CWomments Form <br /> —�� �j CIWMB 183 (New 04104) <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> Inspection /� y� �] {� <br /> Site - I ® 1 _ Report I 1 �L .L '7 I V <br /> Site Suffix: (D J <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> Rkk <br /> 42408 <br /> jEi,XjA1MjPjLjEj jiliC3 ; <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />